Abstract: SA-PO252

Successful Multitarget Therapy in Refractory Lupus Nephritis: A Retrospective Cohort

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Oliveira, Camila Barbosa lyra, Hospital das Clínicas - UFPE, Recife, Brazil
  • Costa, Denise Maria do nascimento, Hospital das Clínicas - UFPE, Recife, Brazil
  • Vajgel, Gisele, Hospital das Clínicas - UFPE, Recife, Brazil
  • Vasconcelos, Carolina Andrade jordão, IMIP, Recife, Pernambuco, Brazil
  • Cavalcante, Maria Alina G.M., Hospital das Clínicas - UFPE, Recife, Brazil
  • Valente, Lucila Maria, Hospital das Clínicas - UFPE, Recife, Brazil
Background

Multitarget therapy (MT) with mycophenolate mofetil (MMF), calcineurin inhibitor and steroids has been studied for induction treatment of lupus nephritis (LN). Nevertheless, its use in refractory LN is still being evaluated.

Methods

Retrospective cohort study of adult patients with refractory LN (EULAR/ERA-EDTA recommendations) treated with MT. Clinical characteristics, serological data and long-term follow-up were analyzed. Complete response (CR) and partial response (PR) were defined by KDIGO Clinical Practice Guideline for Glomerulonephritis.

Results

Data from 8 patients with refractory LN are shown in Table 1. The mean age was 34.6 ± 6 years and 87.5% were female. Mean sCr was 0.8 ± 0.2 mg/dl and median proteinuria was 3.7 (3.1 – 4.1) g/24h. All patients were treated with MMF (1 – 2g/day) plus cyclosporine A 2.5 – 4.0 mg/Kg/day (7 patients) or tacrolimus 0.06 mg/Kg/day (1 patient) plus steroids. After a follow-up of 18 (7.5 – 29.8) months, 7 patients had CR or PR, mean sCr was 1.0 ± 0.3mg/dl and median proteinuria was 1.4 (0.8 – 2.0) g/24h. There were no major adverse events (severe infections or drug nephrotoxicity).

Conclusion

MT successfully induced CR or PR in most patients with refractory LN with no major adverse events.

Table 1. Patients characteristics and long-term follow-up of Multitarget Therapy in refractory lupus nephritis
NoAge (yrs)GenderISN/RPS ClassificationBefore Multitarget TherapyMultitarget Therapy
Induction TreatmentsCr
mg/dl
Prot
g/24h
6 months12 monthsLast visit
sCr
mg/dl
Prot
g/24h
sCr
mg/dl
Prot
g/24h
Time (months)sCr
mg/dl
Prot
g/24h
Response
127FemaleVCYC/MMF/
RTX
0.65.700.81.600.83.00120.83.00PR
231MaleVCYA/MMF1.01.600.90.09  60.90.09CR
341FemaleIV-S A/C + V
67% crescents
MMF/CYC1.04.401.42.70  81.43.30NR
425FemaleIII A + V
10% crescents
CYC/MMF0.93.300.81.300.91.90271.00.97PR
539FemaleIV-G A/C + V
42% crescents
MMF/CYC/
RTX
0.64.500.71.10  60.81.10PR
634FemaleIII A + VMMF/CYC0.64.000.71.800.61.30390.61.70PR
735FemaleIII A/C + VCYC/MMF1.12.401.22.51.41.20241.31.70PR
842FemaleIV-S A/C + V
32% crescents
CYC/MMF1.14.000.91.21.10.05380.90.23CR

ISN/RPS: International Society of Nephrology / Renal Pathology Society – CYC: Cyclophosphamide – MMF: mycophenolate mofetil – RTX: Rituximab – CYA: Cyclosporine A – sCr: creatinine – Prot: proteinuria – CR: complete response – PR: partial response – NR: no response